Laserfiche WebLink
WATER SUPPLY WELL LOCATION SURVEY FORM <br /> POZO DE AGUA POSICION/ FORMA DE ENTREVISTA <br />' SECOR International <br /> 34 75 West Shaw Ave, Suite 104 <br />' Fresno, California <br /> (559)271-2650 <br />' October 1 Octubre 2004 <br />' Well Survey Site Address/Pozo de Sitio de Entrevista 1� <br /> Street/Calle 1 k,rc, K <br /> City/Cuidad 0 C <br /> State/Estado, Zip Code/C6dtgo Postal Q)52 y[� <br /> es i No <br /> A water well is present on the property?[Un pozo de agua esti presente sobre la <br /> liecaracteristica(proptedad)9 <br /> Domesttc/Drtnktng water well/Pozo de agua Dornestico/potable <br /> AgrtculturallLandscape water well/Pozo de Agua agricola/paisale <br /> Unlmown/Desconocido <br />' Y s/ No <br /> Is the well being used?/LPozo el es usado <br /> If known,please provide well construction details/Si conocido,por favor sumintstre pozo detalles de <br /> construccift <br />' Date mstalled/Fecha tnstalada <br /> Depth of well/Profundtdad de Pozo <br /> Casing Type/Ttpo de Cubterta <br />' Casing dtameter/Difimetro de cubterta <br /> Screen mterval/Intervalo de pantalla <br />' Survey completed by/Revtsthn completada por -- <br /> Name/Nombre Stephanie Furgal of SECOR for homeowner/husmess owner <br />' <br /> Signature/Firma al�-s <br />' Date/Fecha �6 <br />